Gallstones, cholesystitis, cholelithiasis
Description: Stones in the gallbladder are relatively common in Western society, and are seen in 6 to 9% of men and women. In most cases they cause no symptoms, and can be ignored. There is no suggestion that gallstones causing no problems should be removed.
They can however cause complications either by sometimes irritating the gallbladder, but more commonly travelling down one of the bile ducts and blocking it causing gallbladder colic pain (an intense dull discomfort under the ribs on the right hand side, the pain is usually continuous and can be associated with sweating and nausea. This pain can last up to 6 hours. Sometimes this can cause inflammation of the gallbladder (cholecystitis) and the stone blocks the entrance to the pancreas it can also cause pancreatitis.
What doctors can do
What the doctors can do –
the major treatment has always been removal of the gallstones surgically, and with keyhole surgery this is a much smaller operation than it has been in the past. If there is concern that one of the stones maybe blocking the bile duct lowdown, a technique called ERCP (endoscopic retrograde cholangiopancreatography) can be used to check that the ducts are clear, and remove any smaller stones.
What you can do
- regular exercise somehow reduces the complication rate of gallstones
- Lose weight (surgeons used to joke that a typical gallstone patient was "female, fat, fertile and forty" but surgeons have not always been PC and are often wrong). However losing weight can be beneficial.
- surprisingly drinking alcohol (small amounts or moderation) may possibly help, but the evidence is very weak.
- Vitamin C also appears to reduce the development of gall stones, especially in women.
- Coffee consumption has been shown to reduce gallstone development in men and women
- Removing the gallbladder is almost routine when surgery is performed, and with time and more sophisticated investigations (ERCP) this could be lessened. But because the gallbladder is useful for digestion, many patients after gallbladder surgery develop got symptoms like indigestion, bloating, diarrhoea and poor absorption. This is because the gallbladder stores bile and bile acids which are essential to properly dissolve and absorb fats.
- Some people suggest taking bile salts with every meal to make up for this poor absorption.
- Diet after gallbladder removal – it is better to go easy on fats, avoid high fat food, fried and greasy foods and fatty sauces and gravy. Increase the amount of fibre in your diet, and it smaller and more frequent meals.
- Also notice other foods that tend to worsen diarrhoea such as caffeine, dairy products, greasy food and very sweet foods, and avoid or reduce these.
- Gallbladder flushes - fasting, drinking olive oil, fruit juices and enemas have not been shown to be beneficial and probably should not be considered.
- Rowachol is a proprietary medicine which has been around for over 50 years, it is believed to increase bile production and may reduce stone formation, and appears to dissolve small non calcified gall stones. Current advice is that it could be considered in people not fit for surgery with small symptomatic stones.
- Supplements – there are no supplements (possibly other than vitamin C – see above), which can reduce the incidence of gallstones or reduce their symptoms. However after gallbladder surgery, because absorption particularly of the fat-soluble vitamins is reduced, supplements are essential. Everybody should be taking:
- a good multivitamin and multi mineral
- vitamin D at least 5000 international units daily,
- vitamin C 1 to 2 grams daily
- additional vitamin E if it is not a multivitamin
- additional vitamin E a again if it is not present in the multi-.
- mega-3 fish oils do appear to be beneficial, and don't usually aggravate the diarrhoea, at least a gram a day
- Probiotics - poor absorption can affect the gut bacteria, and regular use of a probiotic is a good idea.
The Nutritional supplements I use and recommend to my patients
For Post gall bladder surgery patients - USANA - Cellsentials * , Biomega, vitamin C, and vitamin D and probiotics.